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Innovations in Cognitive Behavioral Therapy

Innovations in Cognitive Behavioral Therapy. Ellen J. Teng, Ph.D. February 2011. Treatment Barriers for Returning Veterans. Difficulty getting time off work Family, work, school commitments Reliable means of transportation Stigma of mental illness Denial / poor understanding of symptoms.

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Innovations in Cognitive Behavioral Therapy

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  1. Innovations in Cognitive Behavioral Therapy Ellen J. Teng, Ph.D. February 2011

  2. Treatment Barriers for Returning Veterans • Difficulty getting time off work • Family, work, school commitments • Reliable means of transportation • Stigma of mental illness • Denial / poor understanding of symptoms

  3. Intensive Panic Control Treatment(IPCT) • Evidence-based cognitive-behavioral treatment (CBT) for panic disorder reformatted into an intensive two-day treatment • Offered over the weekend • Structured and presented like a class • Small cohort of Veterans

  4. Patient Characteristics (N=10) • Mean age: 28.8 years (4.39) • Gender: 60% men; 40% women • Education • Some College 80% • Graduated H.S. 20% • Partnership Status • Single 10% • Married 60% • Separated 10% • Divorced 10% • Cohabitating 10% • Race • Caucasian 60% • Hispanic 30% • African American 10% • Service Connection: 20% (Anxiety related diagnoses)

  5. Recruitment & Retention Referred for Treatment 26 73% Interested in IPCT 19 84% Attended Baseline Screen 16 63% Entered Treatment 10 100% Completed Treatment 10

  6. Intensive Panic Control Treatment (IPCT) SATURDAY 9:00 Introduction and Overview 9:30 Causes of Panic and Treatments 10:30 Tracking Panic Attacks 11:00 Break 11:15 Cycle of Panic 12:00 Lunch 12:30 Fight/Flight Response & Mistaken Beliefs 1:30 Breathing Retraining 2:00 Break 2:15 Examining Your Thoughts 3:30 Wrap Up SUNDAY 9:00 Review Thought Records 9:30 Testing Scary Thoughts & Facing Your Fear 11:15 Break 11:30 Facing Situations 12:15 Lunch 12:45 Overcoming Agoraphobia 1:30 Relapse Prevention 2:15 Break 2:30 Complete Forms 3:00 Wrap Up

  7. Results

  8. Results F(2,12) = 24.94, p < .001, η2=.806

  9. Results Acceptability & Satisfaction of IPCT: Treatment Evaluation Inventory (range: 9-45) • M=39 (4.78) Client Satisfaction Questionnaire (range: 8-32) • M=30.9 (2.28)

  10. Patient Feedback • "There is no comparison to other treatments. This is a very good treatment." • "I believe this treatment will be more beneficial to me than taking medications.” • Like most about treatment • "I had time to ask as many questions; had enough time to take notes. Using our examples rather than outside examples helped me." • "The input of other people in the group." • "I like the idea of facing my fear with the knowledge given so that I can again regain my freedom and independence." • Like least about treatment • "I don't think I was completely ready for what to expect during the exposure exercises." • "Spinning in the chair." • "I felt everything we did was necessary whether I felt uncomfortable or not. It was all very empowering."

  11. Implications The brief intensive weekend treatment… • was rated high in acceptability & satisfaction • can be safely and effectively delivered • is a potentially effective treatment for PD and related symptoms • Using patient-specific examples • Strategic ordering of modules • Providing lunch • is a portable treatment that can be delivered to rural and other underserved patient populations

  12. Providing Treatment Maintenance for Panic through Smart Phone Technology • Guide View - Program developed at NASA • SC MIRECC Pilot Project: 1. Content Development 2. Application Development 3. Evaluation • Panic Application will contain 3 modules • Psychoeducation • Coping Techniques • Symptom Monitoring

  13. Potential Implications • Integrating technology with an effective brief treatment overcomes many barriers rural Veterans face by increasing access to treatment and improving continuity of care

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